He emphasized that all patients should receive high-quality discharge processes, "but effective and potentially expensive interventions like those mentioned above should be reserved for those patients most likely to benefit."

In an invited commentary in the same issue, Eric Marks, MD, of the Department of Medicine of the Uniformed Services University of the Health Sciences in Bethesda, MD, suggested that the Brigham and Women's score deals "primarily with severity of illness, which is "commonly identified as a major contributor to the risk of subsequent admissions, but specifics as to how these risks can be modified or contained continues to be an issue."

The other problem is what to do about it, with "documented adherence" to well-known interventions failing to consistently reduce readmission frequency.

Even the penalty, now up to 3% of a hospital's Medicare base DRG for three conditions, has failed to prompt a significant reduction in readmission rates so far, although some progress has been seen.

"This lack of significant improvement in readmission rates suggests that there is a much more complex relationship between risk factors, interventions, and intended outcomes," Marks wrote.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.